Clovis Kiomitsu Takiguti

Testes neuropsicológicos de aplicação simples para o diagnóstico de demência

Thirty patients with dementia defined by DSM-III-R criteria (Alzheimers disease (22), vascular dementia (3), Parkinsons disease, frontal lobe dementia, possible diffuse Lewy body dementia, normal pressure hydrocephalus and uncertain diagnosis), with scores below 24 points in the Mini-Mental Status Examination and more than 4 years of education were submitted to a neuropsychological evaluation. The scores in the neuropsychological tests were compared to those obtained by thirty normal volunteers paired for age, sex and education. Sensivity, specificity and accuracy of the tests in the distinction of demented and normal volunteers were determined. The accuracies were calculated using ROC curves. Blesseds information-memory-concentration test showed greatest accuracy, followed by copy of simple figures, delayed memory of 10 figures (after 5 minutes), recognition of 10 figures and verbal fluency test (animals). A linear discriminant function, composed by 6 tests: visual perception, incidental memory, delayed memory (after 5 minutes), drawing of a clock, verbal fluency (animals) and calculation tests, was able to discriminate all controls from patients and only one patient was wrongly classified as normal control. These tests were chosen because they can be applied in less than 10 minutes and are very easy to interpret. This discriminant function must be applied in another group of patients and controls in order to demonstrate its value. When associated to the MMSE it may be useful to discriminate patients with dementia from normal people in epidemiological studies.Thirty patients with dementia defined by DSM-III-R criteria (Alzheimers disease (22), vascular dementia (3), Parkinsons disease, frontal lobe dementia, possible diffuse Lewy body dementia, normal pressure hydrocephalus and uncertain diagnosis), with scores below 24 points in the Mini-Mental Status Examination and more than 4 years of education were submitted to a neuropsychological evaluation. The scores in the neuropsychological tests were compared to those obtained by thirty normal volunteers paired for age, sex and education. Sensitivity, specificity and accuracy of the tests in the distinction of demented and normal volunteers were determined. The accuracies were calculated using ROC curves. Blesseds information-memory-concentration test showed greatest accuracy, followed by copy of simple figures, delayed memory of 10 figures (after 5 minutes), recognition of 10 figures and verbal fluency test (animals). A linear discriminant function, composed by 6 tests: visual perception, incidental memory, delayed memory (after 5 minutes), drawing of a clock, verbal fluency (animals) and calculation tests, was able to discriminate all controls from patients and only one patient was wrongly classified as normal control. These tests were chosen because they can be applied in less than 10 minutes and are very easy to interpret. This discriminant function must be applied in another group of patients and controls in order to demonstrate its value. When associated to the MMSE it may be useful to discriminate patients with dementia from normal people in epidemiological studies.

Meningite bacteriana neonatal: estudo prospectivo da evolução a longo prazo de 55 crianças

Fifty-five infants who presented bacterial neonatal meningitis were prospectively studied to analyze the frequency and the type of sequelae. All the infants were full term newborns. There were 38 boys and 17 girls; the age of disease onset varied from 3 to 28 days. The causative organism was represented mainly by enterobacteriae. The median time of follow-up was 5 years. The frequency of neurologic sequelae was 63.7%, represented mainly by neuropsychomotor development delay (58.2%), hydrocephaly (45.5%) and convulsions (34.5%). Severe motor abnormalities ocurred in 23.6% of children (quadriplegia, diplegia, hemiparesia and ataxia). Convulsions in the acute phase of the disease and the positive cerebrospinal fluid culture were highly associated to sequelae. The school performance, obtained in 25 children, showed presence of disabilities in 48% of cases, which were significantly associated to mental retardation.

Tratamento da infecção experimental de ratos por Strongyloides venezuelensis mediante uso da ivermectina e do levamisol injetáveis

Para tratamento da estrongiloidiase humana disseminada sao desejaveis medicamentos eficientes em debelar o parasitismo por larvas e vermes adultos e, aplicaveis tambem pela via parenteral, para contornar dificuldades motivadas pelo estado de determinados pacientes. Por isso, foi realizado estudo baseado na infeccao experimental de ratos pelo Strongyloides venezuelensis e administracao de ivermectina ou de levamisol injetaveis. Os dois farmacos mostraram-se ativos quando usados em doses unicas, de 0,2 a 0,5 mg/kg e 26 mg/kg, respectivamente, de ivermectina e levamisol, sendo que o primeiro revelou discreta superioridade para a fase larvaria enquanto o segundo, para os helmintos adultos. Assim, ficaram delineadas promissoras perspectivas para aprimoramento da terapeutica capaz de beneficiar pacientes com infeccao generalizada, comumente grave, devida ao Strongyloides stercoralis.

Avaliação da atividade terapêutica do albendazol em ratos experimentalmente infectados com Strongyloides venezuelensis

Com a finalidade de demarcar mais precisamente o espectro de acao do albendazol, foi estudada a atividade terapeutica desse anti-helmintico em ratos experimentalmente infectados com Strongyloides venezuelensis, tendo sido usada, como termo de comparacao, a acao do cambendazol e do mebendazol, dois outros benzimidazolicos. Os tres compostos mostraram-se eficientes quando utilizadas doses unicas de 6,75, 12,5, 25 e 50 mg/kg, pois motivaram desaparecimento total das formas adultas no intestino. Com a posologia de 5 mg/kg sucederam porcentagens medias de reducoes dos numeros de vermes de 87%, 98% e 80%, respectivamente, como decorrencia do emprego do albendazol, do cambendazol e do mebendazol, traduzindo superioridade da segunda droga citada.

Avaliaçäo terapêutica do oltipraz na infecçäo humana pelo S. mansoni

Seventy two patients with schistosomiasis mansoni, registered in the Infectious and Pa- rasitic Disease Ward, Hospital das Clinicas, Faculty of Medicine, University of Sao Paulo, were treated iyrith a single oral dose of oltipraz, 30 mg/kg body weight. Their ages ranged from seven to 58 years and eight patients (11.1%) were under fifteen. The main side effects found in this trial were: dizziness 22.2%; drowsiness 21%; nausea 22.2%; headache 9.7%; asthenia 9,7%; paresthesia 8.3%; vomiting 3.3%; abdominal cramps 7.0%; diarrhea 4.2%; dry mouth 2.8%; tender nodules in extremities 2.8°/o; exanthema 2.8%. Other complaints were seen less often. The drug toxicity was evaluated by workout — blood counts, kidney function tests (BUN and creatinine), hepatic function test (serum enzymes and bilirubin), EKG and EEG — performed before as well as after treat ment. No relevant abnormality was found. Success of therapy was assessed in 49 patients through eight consecutive stool examinations, performed during the six-month period follow ing the drug administration. Both Hoffmans and Kato-Katzs techniques were used. Rectal biopsies were carried out in 20 patients out of 29 whose stool examinations were negative and just one yielded positive, indicating a 5% rate of false negative examinptions. The overall cure rat^ was 59.2%. The present results point out that oltipraz at the used dose levels is relatively efficaceous in the treatment of schistosomiasis mansoni. Its toxic reactions and side effects on the other hand require further investigation.

An objective reconstruction of the chain of contagion

Norths clustering method, which is based on a much used ecological model, the nearest neighbor distance, was applied to the objective reconstruction of the chain of household-to-household transmission of variola minor (the mild form of smallpox). The discrete within-household outbreaks were considered as points which were ordered in a time sequence using a 10-40 day interval between introduction of the disease into a source household and a receptor household. The closer points in the plane were assumed to have a larger probability of being links of a chain of household-to-household spread of the disease. The five defining distances (Manhattan or city-block distance between presumptive source and receptor dwellings) were 100, 200, 300, 400 and 500 m. The subchain sets obtained with the five defining distances were compared with the subchains empirically reconstructed during the field study of the epidemic through direct investigation of personal contacts of the introductory cases with either introductory or subsequent cases from previously affected households. The criteria of fit of theoretical to empirical clusters were: (a) the number of clustered dwellings and of subchains , (b) number of dwellings in a subchain and (c) position of dwellings in a subchain . The defining distance closest to the empirical findings was 200 m, which fully agrees with the travelling habits of the study population. Less close but acceptable approximations were obtained with 100, 300, 400 and 500 m. The latter two distances gave identical results, as if a clustering ceiling had been reached. It seems that Norths clustering model may be used for an objective reconstruction of the chain of contagious whose links are discrete within-household outbreaks.

Pesquisa do antígeno polissacarídico do Schistosoma mansoni em soros de hamsters pela técnica de imunoeletroforese cruzada

Crossed immunoelectrophoresis (IEC) was used for detection of free and complexed circulating polisaccharide anodic antigen (AgCA) of Schistosoma mansoni in sera of infected hamsters. An attempt was also done to detect AgCA in human sera from patients infected with S. mansoni. The conditions for isolation and detection of complexed AgCA were established. The sensitivity of IEC was increased by incorporation of 2% polyethylene glicol (PEG) to the agarose and by maintaining the system at 4°C during the electrophoretic run. Free AgCA was detected in 12 and the complexed in 30 of the 37 hamsters sera analysed. Correlation between AgCA (free and complexed) and the parasite load was observed. AgCA was not detected, under the experimental conditions used, in human sera from 7 patients in the acute and 23 in the chronic phase of infection.

Uma abordagem ao estudo de epidemias de moléstias contagiosas: modelo conceitual baseado nas escalas espaciais e funcionais da propagação epidêmica

Propoe-se, uma nova abordagem para a solucao do problema da metodologia padronizada, em epidemias. Consiste em um modelo conceitual, onde: (a) Integram-se os componentes da epidemia de acordo com esse metodo amplamente utilizado por geografos, quando da difusao de inovacoes. Justifica-se pelo isomorfismo entre esta difusao e a disseminacao de uma doenca infecciosa, (b) Essa sistematica tem em si, implicitos, os dados a serem colhidos no campo do surto epidemico. Inclui, a intercorrelacao dos elementos de composicao do evento, permitindo a elucidacao metodica (nao simplesmente intuitiva) do mecanismo da propagacao do mesmo, (c) O inter-relacionamento daqueles varios elementos, e feito racionalmente, pois sao utilizadas inumeras escalas espaciais (aspectos estaticos) e funcionais (aspectos dinâmicos). A falha em identificar o conceito de escala (basico) tem provocado muita confusao e, principalmente, evitado progressos importantes na analise epidemica. Com efeito, essa nao identificacao da unidade de escala, tem prejudicado a padronizacao em epidemias.Propoe-se, uma nova abordagem para a solucao do problema da metodologia padronizada, em epidemias. Consiste em um modelo conceitual, onde: (a) Integram-se os componentes da epidemia de acordo com esse metodo amplamente utilizado por geografos, quando da difusao de inovacoes. Justifica-se pelo isomorfismo entre esta difusao e a disseminacao de uma doenca infecciosa, (b) Essa sistematica tem em si, implicitos, os dados a serem colhidos no campo do surto epidemico. Inclui, a intercorrelacao dos elementos de composicao do evento, permitindo a elucidacao metodica (nao simplesmente intuitiva) do mecanismo da propagacao do mesmo, (c) O inter-relacionamento daqueles varios elementos, e feito racionalmente, pois sao utilizadas inumeras escalas espaciais (aspectos estaticos) e funcionais (aspectos dinâmicos). A falha em identificar o conceito de escala (basico) tem provocado muita confusao e, principalmente, evitado progressos importantes na analise epidemica. Com efeito, essa nao identificacao da unidade de escala, tem prejudicado a padronizacao em epidemias.